須田 康一

BACKGROUND: The incidence of chemotherapy-induced nausea and vomiting (CINV) when using an oxaliplatin-based regimen may vary according to the cancer type. This study compared the occurrence of CINV in patients with gastric or colorectal cancers. METHODS: This retrospective study included patients who received oxaliplatin-containing regimens for gastric or colorectal cancer. The incidence of CINV during the first treatment course was evaluated. Propensity score matching (PSM) was performed between gastric cancer (GC) and colorectal cancer (CRC) groups to compare the complete response (CR) and total control (TC) rates as indicators of antiemetic efficacy. The impact of primary tumor resection history, surgical procedure, and antiemetic agents was analyzed in the group with a higher incidence of CINV. RESULTS: The GC group included 99 patients and the CRC group included 180 patients, with 60 patients per group, after PSM. The CR rate was significantly lower in the GC group (75.0%) than in the CRC group (95.0%) (P < 0.01). Before PSM, the TC rate varied significantly by resection type in patients with GC (P = 0.012), indicating that tumor resection influenced the TC rate (P = 0.015). In patients with GC who underwent tumor resection, neither dopamine 2 receptor antagonists (P = 0.090) nor neurokinin 1 receptor antagonist (P = 0.66) use was associated with a significant difference in the CR rate. CONCLUSION: Patients with GC have a higher incidence of CINV than those with CRC. In patients with GC, tumor resection significantly influenced the total control rate of CINV.

BACKGROUND: Late biliary complications, consisting of anastomotic stricture and cholangitis, are known to impair long-term quality of life and significantly impact patient outcomes following robot-assisted pancreaticoduodenectomy (RPD). The role of stent placement in HJ remains debatable. This study aimed to investigate the incidence of late biliary complications and the impact of stent placement on long-term outcomes after RPD. METHODS: This retrospective observational study included patients who underwent RPD from November 2009 to April 2024 at two institutions. Patients were categorized into no-stent, internal stent, and external stent groups. The incidence of late biliary complications was analyzed with Kaplan-Meier estimates and Cox proportional hazards models. RESULTS: The analysis included 157 patients. Late biliary stricture occurred in 20 (13%) cases, with 17 (11%) cases being nontumor-related. No cases of late biliary stricture were observed in patients with a preoperative bile duct diameter of ≥ 15 mm. Internal stent placement was determined as an independent protective factor against late biliary stricture compared to no-stent placement among patients with a bile duct diameter of < 15 mm (hazard ratio: 0.310, 95% confidence interval: 0.096-0.999, p = 0.050). Spontaneous dislocation of internal stents occurred in 71% of cases at 6 months postoperatively. The incidence of postoperative late cholangitis in the internal stent group was 17% (15/89), which was not significantly different compared with the no-stent group (30%, 12/40; p = 0.237). External stent placement prolonged hospitalization and was not superior in biliary complication prevention. CONCLUSIONS: Internal stent placement may decrease the incidence of late biliary stricture after RPD and should be considered a preferred strategy for biliary reconstruction, except in cases with significant bile duct dilatation.

BACKGROUND: Trifluridine/tipiracil (FTD/TPI) plus bevacizumab (BEV) is a standard third-line therapy for unresectable advanced or recurrent colorectal cancer. The standard dosing schedule (5 days of administration followed by 2 days off) is associated with a high incidence of severe neutropenia. Conversely, a biweekly dosing schedule (5 days of administration followed by 9 days off) reportedly reduces this incidence. However, no direct comparison of these regimens has been made. In this study, we retrospectively compared the efficacy and safety of these two dosing schedules. METHODS: We analyzed data from patients who received FTD/TPI + BEV treatment between June 2016 and January 2024 at three hospitals affiliated with Fujita Health University. The effects of the dosing schedules on hematological toxicity, overall survival (OS), and time to treatment failure (TTF) were assessed. RESULTS: Among the 125 patients, 26 and 99 were classified into the standard and biweekly groups, respectively. Grade ≥ 3 neutropenia occurred in 50.0% of patients in the standard group and 29.3% of those in the biweekly group (P = .062), with multivariable analysis confirming the dosing schedule impact (P = .048). Median TTF was 5.4 and 7.0 months, while median OS was 16.4 and 14.5 months (P = .908, 0.947) in the standard and biweekly groups, respectively. CONCLUSION: The biweekly regimen of FTD/TPI + BEV resulted in a lower tendency for severe neutropenia than that in the standard regimen, while maintaining comparable OS and TTF in patients with unresectable advanced or recurrent colorectal cancer.

PURPOSE: To develop an educational program that enables young surgeons to safely perform laparoscopic transabdominal preperitoneal repair (TAPP). METHODS: This retrospective study comprised 365 patients who underwent elective TAPP performed by surgical residents (SRs; n = 145 patients) and board-certified surgeons (BCSs; n = 220 patients) from January 2018 to December 2023. An educational program for SRs has been underway since April 2021 to facilitate efficient learning and ensure the safe performance of TAPP. This program comprises four steps and highlights the two points mentioned, including understanding technical principles and acquiring fundamental skills. The surgical outcomes of laparoscopic TAPP performed by SRs and BCSs were compared retrospectively. RESULTS: A total of 43 operators (16 SRs and 27 BCSs) performed the laparoscopic TAPP. The SRs demonstrated longer operative times (median 126 vs. 98 min; p < 0.01). No significant differences in the rates of seroma (7.6% vs. 5.5%), grade IIIa or higher Clavien-Dindo complications (early: 0.7 vs. 0.9%; late: 0.7% vs. 0%), and recurrence at 1 year after surgery (1.4% vs. 0.5%) were observed between the SR and BCSs groups. Following the implementation of the educational program in April 2021, laparoscopic TAPP procedures performed by SRs were associated with significantly shorter operation times compared to those conducted before the program was introduced. CONCLUSIONS: SRs who received presurgical education improved the operative time in laparoscopic TAPP, although with intraoperative guidance from Endoscopic Surgical Skill Qualification System-qualified surgeons.

BACKGROUND: Biliary tract cancer (BTC) is a type of malignancy that is challenging to manage. Further, advanced-stage BTC has poor prognosis. Based on the recent TOPAZ-1 trial, adding durvalumab to gemcitabine and cisplatin significantly improves survival in unresectable BTC, thereby making it the new standard first-line treatment. However, real-world data are essential to validate its efficacy and safety in routine clinical settings, which often involve older patients and those with comorbidities or previous therapies. This study aimed to evaluate the outcomes of combination chemotherapy with gemcitabine, cisplatin, and durvalumab (GCD) in a real-world cohort with BTC. METHODS: This retrospective analysis included patients with unresectable advanced-stage BTC treated with GCD between December 2022 and April 2024 at three institutions. GCD was administered for up to eight cycles, followed by durvalumab monotherapy. Clinical data, including the characteristics of the patients, adverse events, and treatment responses, were collected. The Kaplan-Meier method and the Cox proportional hazards model were used to assess progression-free survival (PFS), overall survival (OS), and other factors affecting outcomes. RESULTS: The current study included 54 patients with a median age of 72 years. Half of the patients had recurrence post-surgery, and many of them had previously received chemotherapy. The median PFS and OS rates were 4.1 and 8.0 months, respectively. Adverse events (AEs) were frequently observed, with 42.1% of patients presenting with grade 3 or higher AEs. However, immune-related AEs were rare and mild. Dose adjustments, which are often caused by renal impairment or fatigue, were common (66.7%). Multivariate analysis revealed that older age, a lower performance status score, and a high neutrophil-to-lymphocyte ratio (NLR) were significant predictors of a shorter PFS. Further, a lower performance status score, and a high NLR were associated with a low OS. CONCLUSIONS: GCD combination chemotherapy is a viable treatment option for advanced-stage BTC in a real-world setting where dose modifications can improve tolerability among elderly patients. Neutrophil-to-lymphocyte ratio can be a prognostic biomarker of OS in patients with BTC receiving immune checkpoint inhibitors. This finding highlights the potential of individualized treatment strategies. Nevertheless, further research should be performed to validate these results in larger cohorts.